임신 중 비정상 자궁세포검사
Abnormal cervical cytology in pregnancy
Pregnant women — The evaluation and management of pregnant women is different from non-pregnant women because of the risk that trauma to the cervix could lead to preterm labor or delivery.
PAP
| ASC-US | 분만 후 재검 |
| LSIL | 분만 후 재검 (Acceptable) 혹은 분만전 확대경 (Preferred) and/or 조직검사1) |
| ASC-H,AGC, HSIL | 분만전 확대경 and/or 조직검사2) |
- The rate of CIN 2,3 is only 3.7 percent on postpartum follow-up for women with prenatal ASC-US or LSIL.
ASC-US
Pregnant women with ASC-US and a positive HPV test may elect to have Colposcopy during pregnancy or wait until at least six weeks after delivering their baby.
The reason for this recommendation is that cervix appears somewhat different during pregnancy, which can make it difficult to determine if an area appears abnormal due to pregnancy or due to precancerous changes. In addition, most mild abnormalities resolve over time without treatment.
ASC-H
Pregnant women with ASC-H should have a colposcopy. This is because ASC-H is more likely than ASC-US to be caused by a precancerous change. Management after colposcopy depends upon the result of the biopsy (see below).
5 year cancer rate 2%
CIN3+ risk is between LGSIL and HGSIL
LSIL
Colposcopy is recommended for pregnant women with LSIL, similar to non-pregnant women. Management after colposcopy depends upon what the biopsy shows.
Punch Biopsy
| CIN I | 분만 후 재검 |
| CIN II,III | 3-4개월 간격 확대경 & PAP |
The indications for colposcopy in pregnant women are essentially the same as in non-pregnant women. If a lowgrade lesion (ASCUS or LSIL) is found during pregnancy, the Pap smear should be repeated 3 months postpartum. This practice is safe as the rate of cancer in this group is very low.
If HSIL, ASC-H, or AGC is found, prompt evaluation with colposcopy is essential. If colposcopy is unsatisfactory in the first trimester, it should be repeated after 20 weeks’ gestation when, because of the physiological changes, the cervix everts itself and the squamocolumnar junction may become visible.
확대경검사
CIN 3 이나 암이 의심되는 경우에는 조직검사를 시행한다3) 임신 중 조직검사는 해롭지 않다는 증거가 있다.
고등급이형성증이 있는 산모는 반드시 경험 있는 부인과의사가 진료하도록 한다.
저등급(LSIL)이나 ASC-US 인 경우 3개월 후에 세포검사를 다시 시행한다.
Pregnant women with HSIL, ASC-H, or AGC should be referred for colposcopy within 4 weeks. (III-B)
Endocervical curettage should not be performed during pregnancy. (III-D)
Management after colposcopy
- CIN 1 — Pregnant women with CIN 1 are usually advised to defer further evaluation and treatment until at least 6 weeks after delivery of the baby. The reason for this recommendation is that most mild abnormalities will resolve over time without treatment.
- CIN 2 or 3 — If there is evidence of CIN 2 or 3, colposcopy and cervical cytology testing may be done every 3 to 4 months during the pregnancy, or further evaluation may be deferred until at least 6 weeks after the woman delivers her baby. Treatment to remove the abnormal area is not recommended during pregnancy.
The reason for this recommendation is that CIN 2 or 3 is caused by precancerous changes that have the potential to become cancerous when untreated. This is a slow process that takes many months to years. As long as the abnormality is monitored, it is not necessary to remove the area (and increase the risk of preterm delivery or miscarriage) until after delivery.